Instrument for stitching gastric stump



Feb. 26, 1963 B. s. BOBROV INSTRUMENT FOR STITCHING GASTRIC STUMP 3Sheets-Sheet 1 Filed Sept. 9, 1959 Feb. 26, 1963 B. s. BOBROV INSTRUMENTFOR s'rI'rcHING GASTRIC saw? 3 Sheets-Sheet 2 Filed Sept. 9, 1959 Feb.26, 1963 B. s. BOBROV 3,078,465

INSTRUMENT FOR STITCHING GASTRIC STUMP Filed Sept. 9, 1959 5Sheets-Sheet 3 l a l wm-v ire tates 3,078,465 INSTRUMENT FOR STITCHINGGASTRIC STUMP Boris Sergueevitch Bobrov, Oktiabrskaja ul. 40, Apt. 10,Moscow, U.S.S.'R. Filed Sept. 9, 1959, Ser. No. 840,491 2 Claims. (Cl.1-50) This invention relates to an instrument for stitching the gastricstump by means of U-shaped tantalum staples.

The existing instruments for suturing the gastric stump by means ofU-shaped metal staples permit the application of only single-row shallowsutures, piercing all the layers of the gastric walls to be stitched.The jaws of these instruments unevenly grip the gastric walls because ofthe elastic deformation of the material of which they aremade, whichlowers the quality of the suture.

-One of the objects of the present invention is an instrument whichensures an even gripping of the intestinal walls-along the line of thesuture.

This object is attained by making the operating part of the supportingjaw in the shape of a rocking arm with stops at the end.

Another object of the present invention is an instrument which haspivotally joined clinching and supporting iaws'w are provided with tworows of slots for staples he forfeach jaw, stitchers for subsequentlyforcing out segmental h arersr the first and second rows, andrecesses'forclinching s'ta giles. Such design allows stitching"of'the"gastric'stunip'by means of a double row of staple sutures. I This aim isattained by the provision on the clinch-in'g'and supfioi'tingjawsof'projections set one against the othei'iaf rid flisplaced"ifi ahalf pitch, and an opening in the center forneedles piercing the upperlayers of the gastric wall, fixing-the gastric walls to the instrumentjaws when driving the'iir'st row of sutures into the lumen of the stumpand placing the second row of sutures in the sero-muscular layers of thegastric walls. The further objects and advantages of the presentinvention are seen from the following description and the attacheddrawings, in which the preferred embodiment of the invention is shown.

FIG. 1 is a side elevational view of the instrument;

FIG. 2 is a top plan view of the instrument;

FIG. 3 is a view of the clinching jaw without a handle and stitchersalong the arrow A in FIG. 2;

FIG. 4 is a view of the supporting jaw along the arrow A in FIG. 2;

FIG. 5 is a cross-section view of the instrument along line B--B of FIG.1;

FIG. 6 is a cross-sectionview of the instrument along line C'C in FIG.1; FIG. 7 is a longitudinal sectional view of the stitcher;

FIGS. 8 to 10 show three types of sutures provided by the instrument ofthis invention;

FIG. 11 is an elevational view showing the details of the needle.

In more detail, and with further reference to the drawings, FIGURE 1discloses the overall construction of the stitch-ing instrument. Theinstrument comprises the elongated clinching jaw 1, the similarlyelongated supporting jaw 2, the stitcher mechanism 3 slidably mounted onthe forward portion of the clinching jaw 1, stitcher 3 being adapted toforce out staples for the first row of sutures piercing all lamina ofgastric walls. A similar stitcher mechanism 4 is also slidably mountedupon the forward portion of the clinching jaw, at a location laterallyadjacent the stitcher mechanism 3, stitcher 4 being adapted to force outstaples for the second row of sutures piercing all sero-muscular lamina.The handle 5 is provided intermediate the length of the jaws for openingand closing the clinching jaw and supporting jaw with respect to eachother. The clinching jaw and supporting jaw are pivotally connected attheir rearward ends 6 by means of the pin 6, and a pair of parallelflange portions 6" having apertures therethrough for receiving andsupporting the pin.

The handle 5' of the stitching instrument, best illustrated in FIGURES 1and 5, for opening and closing the jaws includes a threaded portion '7and an intermediate portion 8. The supporting jaw 2' has a hollow,threaded portion 42 for screwing the threaded portion 7 of the handleinto the supporting jaw. The intermediate portion 8 of the handle is ofreduced size with respect to the interior surface of the hollow openingin the clinching jaw, to provide a spacing 8 therebetween, and therebyaccommodate the arcuate movement of the jaws relative to one another,when opening and closing the jaws.

The handle 5, disposed intermediate the length of the jaws, is rotatablefor screwing its lower end into the supporting jaw, with its uppermoststern portion 5' being enlarged relative to the intermediate portion 8,so that the enlarged portion will press against the clinching jaw andforce it toward the supporting jaw and clamp the gastric stumptherebetween.

The side surface of the elongated clinching jaw 1 (FIGS. 1 and 2), alongits forward portion 13, is provided with a pair of opposed open guidewayslots 9, which extend parallel with the length of the jaws, and providea slide support for the stitcher mechanisms 3 and 4.

Along the length of the forward portion 13 of the clinching jawimmediately beneath each stitcher mechanism, are a plurality of slots10, for the staples. These slots 10 are formed by a pair of elongatedplates 11 and 12, with vertically extending recesses in the platesforming the slots 10 at spaced intervals along the length of the plates.The elongated plates 11 and 12 are secured to the housing 13 of theclinching jaw 1 by means of screws 14.

To facilitate fixing the gastric stump to the clinching jaw, a pluralityof downwardly extending teeth 15 are provided adjacent plate 12, atclosely spaced intervals along the length of the forward portion of theclinching jaw. These projections extend toward the supporting jaw, andare each provided with an eye 16. The eye openings are aligned along apath parallel to the length of the clinching jaw. An elongated needle 17has a rearward portion slidably secured to handle portion 19 of theclinching jaw with the forward needle portion aligned with the eyes 16of the teeth 15 of the clinching jaw. A finger operated projection 18 issecured to the rearward portion of the needle by a screw 20 whichprojects into a longitudinal slot 21 in the handle port-ion 19. Thus,the needle is slidably supported on the handle portion for manualmovement into and out of eyes 16.

The stitcher mechanisms 3 and 4 for applying the first and second rowsof stitches, respectively, are best illustrated in FIGURES l and 7, andare of similar construction. They comprise an upright body portion 22,having grooved portions for slidably supporting the stitcher mechanismin the guideway slots 9 of the clinching jaw. A cover plate 23 issecured to the body portion by means of a plurality of screws. Betweenthe cover plate and the body is a vertically mounted driving plunger 25,slidably mounted in a vertical direction by means of a pin 25 and slot25". A return spring 26 for the plunger has one end connected to theplunger and its intermediate portion connected to the body 22 by meansof a screw 26'. An elastic stop 27 is connected to a slide 28, bysuitable connecting means. The movement of the slide is limited by thelength of the slot 29 in body portion 22 and which extends parallel tothe length of the jaw.

FIGURES 1 and 4 disclose the structure of the supporting jaw 2, whichconsists of a rocking arm 30 pivotally mounted to the forward end of thejaw along an axis transversely of the length of the jaw, and with stops31 for limiting the pivotal movement of the rocking arm relative to theforward end body portion of the jaw. A pin 33 provides the pivotaljoining of the rocking arm 39 to the forward body portion 32 of thesupporting jaw.

The upper portion of the rocking arm is provided with a working surfacewhich includes two rows of recesses 34 for bending the staples forcedout of recesses in the stitching operation. For fixing the gastrix stumpto the supporting jaw, upward extending teeth 35 are provided on theworking surface of the rocking arm having eye openings 36 in the center.The teeth 35 are formed in the same manner as the teeth of the clinchingjaw. The teeth 35 serve for fixing the rear gastric wall to thesupporting jaw. The teeth-like projections 35 project toward thedownwardly extending teeth 15 of the clinching jaw in generally opposedrelation. .How ever, the projections 35 are displaced at half pitch asregards the projections 15 of the clinching jaw. Inside the eyes 36 ofthe projections 35 freely passes a needle 37, which needle has a fingeroperated projection 38 which slidably moves along the handle 39, andhave a con-f struction and operation similar to the projection 18 andneedle 17 of the clinching jaw. The projection 38 is slidably secured tothe handle 39 by means of the screw 40, which enters the longitudinalslot 41.

To bring the instrument jaws together, it is necessary to compress thehandles 19 and 39 with one hand, and at the same time to rotate theturnable handle 5 with the other hand; the screw 7 connected to theturnable handle is turned into the threaded opening 42 of the supportingjaw.

Stitching of the gastric stump with the instrument is carried out in thefollowing way.

The gastric walls are clamped by the instrument jaws along the line of asupposed resection; by bringing them together until the stops 31 of therocking arm engage the surface of the clinching jaw. Therefore, theteeth 15 of the clinching jaw and the teeth 35 approach each other andwill engage the gastric walls. The gastric tissue fills spaces betweenthe teeth of the clinching jaw and rocking arm. Then, by manual pressureon the projections 13 and 38 the needles 17 and 37 pierce the gastricwalls and enter the eyes 16 and 36.

To place the rst row of sutures it is necessary to press the pusher 25of the stitcher 3 with the thumb. When doing this, the pusher will enterthe corresponding slot it and push the staple out of it. The staple withits sharp tips pierces the tissue clamped between the jaws, and isclinched by recess 34.

Downward movement of pusher 25 causes bevel surface 43 thereon to moveslide 28 along slot 29 till elastic stop 27 enters the next staple slot10.

After this the thumb should be removed from the pusher. Under the actionof the return spring 26 the pusher rises to its upper position and isdisengaged from the staple slot 10. The compressed portion 44- of thereturn spring 26 brings the entire mechanism to the next slot, afterwhich the next staple is forced out by the pusher.

The operation is repeated until a suture of a desired length isobtained.

After the first row of sutures has been placed by stitcher 3, theaffected section of the stomach is cut ot along the instrument jaws withthe aid of a scalpel. By turning the handle 5 in the reverse directionthe jaws are opened 5-7 mm.; through the slit thus formed is pushed thelumen of the stump as shown in FIG. 8, the needles 17 and 37 holding theremaining portion of the stomach in place. Then the jaws are broughttogether to the initial position, and sero-muscular sutures 46 as shownin FIG, 8 are applied by the stitcher 4.

1. An instrument for stitching a gastric stump including clinching andsupporting jaws, means hingedly con necting said jaws together, saidSupporting jaw having longitudinal guides thereon, said jaws havingfacing surfaces, the supporting jaw having recesses therein, theclinching jaw having slots therein facing said recesses, staplestitchers movable in the longitudinal guides of the supporting jaw andadapted to drive U-shaped tantalum staples out ofthe slots in theclinching jaw for clinching in the recesses in the supporting jaw, saidstitchershaving levers adapted to be pressed to drive the staples,- saidsupporting jaw including an operatingpart cuaipii sing a rocking arm,stops at the endspf s'aidarr'ns adapted .to contact the clinching jawand said istops being, disposed parallel to the clinchipgzitw. p 2 Aninstrumehttfoi spturingla gastric stump including clinching and .snpport i g ja cans piovtally connecting the jaws togetheratIpne end thereof,staple stitchers carried by,;s aid supporting jaw for applying staplesin a suturing operation, said jaws having facing surfaces having teeththereon spaced longitudinally along the jaws and displaced at a halfpitch from one another so as to corrugate the gastric wall when the jawsare moved toward one another, said jaws having longitudinal slotstherein, needles in said slots, manually operated means adjustablypositioned in the slots, said teeth having eyes in the central portionthereof and said needles being adapted to freely enter the eyes to fixthe stomact wall by the sero-muscular layers when the first row ofsutures is applied to the lumen of the stump and to place a second rowof sutures on the sew-muscular layers of the gastric walls.

Fischer June 7, 1910 Wilson Mar. 14, 1944

1. AN INSTRUMENT FOR STICHING A GASTRIC STUMP INCLUDING CLINCHING ANDSUPPORTING JAWS, MEANS HINGEDLY CONNECTING SAID JAWS TOGETHER, SAIDSUPPORTING JAW HAVING LONGITUDINAL GUIDES THEREON, SAID JAWS HAVINGFACING SURFACES, THE SUPPORTING JAW HAVING RECESSES THEREIN, THECLINCHING JAW HAVING SLOTS THEREIN FACING SAID RECESSES, STAPLE STICHERSMOVABLE IN THE LONGITUDINAL GUIDES OF THE SUPPORTING JAW AND ADAPTED TODRIVE U-SHAPED TANTALUM STAPLES OUT OF THE SLOTS IN THE CLINCHING JAWFOR CLINCHING IN THE RECESSES IN THE SUPPORTING JAW, SAID STITCHERSHAVING LEVERS ADAPTED TO BE PRESSED TO DRIVE THE STAPLES, SAIDSUPPORTING JAW INCLUDING AN OPERATING PART COMPRISING A ROCKING ARM,STOPS AT THE ENDS OF SAID ARMS ADAPTED TO CONTACT THE CLINCHING JAW ANDSAID STOPS BEING DISPOSED PARALLEL TO THE CLINCHING JAW.